Originally published as JCO Early Release 10.1200/JCO.2005.10.167 on October 11 2005

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Fatigue and Relating Factors in High-Risk Breast Cancer Patients Treated With Adjuvant Standard or High-Dose Chemotherapy: A Longitudinal Study

From the University Medical Center Groningen, University of Groningen, Groningen, The Netherlands Cancer Institute; Amsterdam; Erasmus Medical Center/Daniel den Hoed Cancer Center, Rotterdam, University Medical Center Nijmegen St. Radboud, Nijmegen; Free University Hospital, Amsterdam; Medical Spectrum, Enschede, Leiden University Medical Center; University Medical Center, Utrecht; University Hospital, Maastricht, The Netherlands

Address reprint requests to E.G.E. de Vries, MD, PhD, Department of Medical Oncology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; e-mail: e.g.e.de.vries{at}int.umcg.nl

PURPOSE: Determine whether standard or high-dose chemotherapy leads to changes in fatigue, hemoglobin (Hb), mental health, muscle and joint pain, and menopausal status from pre- to post-treatment and to evaluate whether fatigue is associated with these factors in disease-free breast cancer patients.

PATIENTS AND METHODS: Eight hundred eighty-five patients were randomly assigned between two chemotherapy regimens both followed by radiotherapy and tamoxifen. Fatigue was assessed using vitality scale (score 46 defined as fatigue), poor mental health using mental health scale (score 56 defined as poor mental health) both of Short-Form 36, muscle and joint pain with Rotterdam Symptom Checklist, and Hb levels were assessed before and 1, 2, and 3 years after chemotherapy.

RESULTS: Fatigue was reported in 20% of 430 assessable patients (202 standard-dose, 228 high-dose) with at least a 3-year follow-up, without change over time or difference between treatment arms. Mean Hb levels were lower following high-dose chemotherapy. Only 5% of patients experienced fatigue and anemia. Mental health score was the strongest fatigue predictor at all assessment moments. Menopausal status had no effect on fatigue. Linear mixed effect models showed that the higher the Hb level (P = .0006) and mental health score (P < .0001), the less fatigue was experienced. Joint (P < .0001) and muscle pain (P = .0283) were associated with more fatigue.

CONCLUSION: In 3 years after treatment, no significant differences in fatigue were found between standard and high-dose chemotherapy. Fatigue did not change over time. The strongest fatigue predictor was poor mental health.

Supported by a grant from the Dutch Health Insurance Council.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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